摘要
目的分析甲型H1N1流感肺炎危重病例的临床特点及危重症的相关危险因素。方法采用回顾性研究方法分析承德市第三医院2009年9～12月收治的51例新型甲型H1N1流感肺炎患者的临床特点，并对重症病例和危重症病例进行比较分析。结果危重症患者均有呼吸困难，氧合指数为（188．4±68．5）mmHg，APACHEⅡ评分为12．5±4．5。其中10例（41．7％）出现咳痰带血，6例（25．0％）发展至急性呼吸窘迫综合征（ARDS）。危重症组在白细胞升高、淋巴细胞降低、血糖升高、痰培养阳性及应用奥司他韦（300mg／d）、美洛培南、丙种球蛋白、近期康复者血浆、机械通气、糖皮质激素的患者比例上较重症组高（P值均〈O．05）；危重症组受损肺野数量、咽拭子转阴时间、住院时间上较重症组高（P值均〈O．05）。logistic回归分析结果显示：首发症状有咳痰、发病到应用奥司他韦时间〉48h、伴随基础疾病是易于发展至危重症的危险因素（OR值分别为3．181、19．596、7．437，P值均〈0．05）。结论首发症状有咳痰、发病到应用奥司他韦时间〉48h、伴随基础疾病的甲型H1N1流感肺炎患者易发展至危重症；危重症患者受损肺组织广泛且部分合并细菌感染，病毒转阴时间和住院时间长，部分患者进展至ARDS。
Objective To analyze the clinical features of critically ill patients with pneumonia of influenza A HIN1 and the risk factors associated with critically ill patients. Methods The clinical features of 51 patients with pneumonia of influenza A H1N1 hospitalized at Chengde Third Hospital from September to December of 2009 were retrospectively analyzed and the comparative analysis was performed on the clinical features of the severe and the critically ill patients. Results Critically ill patisents all had dyspnea, average oxygenation index was （188.4± 68.5） mm Hg and average APACHE 1I score was 12.5±4.5, and ten patients （41.7 % ） had bloody spumtum, six critically ill patients （25.0 a//00 ） progressed to acute repiratory distress syndrome （ARDS）. The ratios of patients with increased leukocytosis, decreased lymphocytes,elevated blood sugar, positive sputum culture, and received osehamivir （300 mg/d）, meropenem, gamma globulin, convalescen plasma, mechanical ventilation, glucocorticoid were higher in critical group than those in severe group （all P 〈 0.05）. The number of damaged lung field, viral clearance time,and hospitalization time were higher in critical group than those in severe group （all P 〈 0.05）. Logistic regression analysis showed that pneumonia of inflenza A H1N1 with expectoration as initial symptom, the onset to first dose of oseltamivir 〉48 hours,and presences of underlying disease was associated with higher fatal risks （OR was 3. 181,19. 596,7. 437 respectively, all P d0.05）. Conclusions Pneumonia of inflenza A H1NI with expectoration as initial sympom, the onset to first dose of oseltamivir 〉48 hours,and presences of underlying disease is susceptible to critical illness. Damaged lung tissue of critically ill patients is wide and some are complicated with bacterial infection, viral clearance timeand hospital stay are longer,part of patients progress to ARDS.
出处
《国际呼吸杂志》
2013年第14期1046-1050,共5页
International Journal of Respiration
基金
承德市科学技术研究与发展计划项目（20122175）
关键词
甲型H1N1流感
肺炎
危重症
临床特征
危险因素
Influenza A （ H1N1）
Pneumonia
Critical illness
Clinical features
Risk factor
